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First contact practitioners have emerged over recent years in response to growing pressures within the National Health Service (NHS) and are now central to primary care musculoskeletal (MSK) services. Within the MSK field, these allied health professionals can be from a range of disciplines, including physiotherapy, podiatry and osteopathy. Early referral to rheumatology is key to successful long-term management of many inflammatory MSK conditions, but presents challenges to overburdened services. Evidence supporting the recognition and referral of patients with rheumatological disorders by First Contact Practitioners is lacking; however, physiotherapists have been shown successfully to substitute the role of a doctor within the MSK field. This review investigates the value of First Contact Physiotherapists (FCPs) within primary care and their role in early recognition and referral of rheumatological MSK disorders in line with national guidance. FCPs best placed to fulfil the role of MSK champions, positively impacting the whole MSK pathway, with the potential to reduce the burden on rheumatology services. Planned rapid upscaling of FCPs over the next few years will support sustainability of MSK NHS services. [ABSTRACT FROM AUTHOR]

Introducción: La importancia del conocimiento del impacto del trabajo en la salud de las personas se ha acrecentado tras la pandemia por COVID-19. El síndrome de Burn Out (BO) nace de la tensión emergente de la interacción conflictiva entre el trabajador y su empleo. El objetivo fue describir la prevalencia y frecuencia de diagnóstico del BO en el recurso humano en salud de servicios críticos del Hospital Municipal de Bahía Blanca en el contexto de la pandemia COVID-19. Métodos: Estudio descriptivo, de corte transversal. La población de estudio fue el personal médico y de enfermería de los servicios de Terapia intensiva (TI), Médico de Urgencias (SMU) y Clínica que trabajaron con COVID-19 durante el 2021. Se empleó el cuestionario Maslach Burnout Inventory (MBI) y preguntas cerradas complementarias para identificar, entre estos casos, aquellos que fueron diagnosticados y tratados por la institución. Resultados: De los 219 trabajadores, el 55,3% (121/219) fueron enfermeros. En el SMU el 25% (24/96) de encuestados tenía BO, seguido por un 20,4% (11/54) en Clínica y un 8.7% (6/69) en TI (valor p=0.004). Sólo el 5,5% (12/219) del total fue diagnosticado con BO por la institución y de este grupo, dos personas (0,9%) habían consultado previamente por síntomas característicos. Discusión: Se evidenció una elevada prevalencia de BO y un marcado sub-diagnóstico a nivel institucional durante la pandemia. A pesar de que el Servicio de TI tuvo la mayor demanda de atención, fue el que presentó los valores más bajos de BO en relación a otros servicios.

Musculoskeletal (MSK) first contact physiotherapy (FCP) is being rolled out in the National Health Service, but limited research exists on career pathways into MSK FCP, or on pre-and-post-registration educational preparation for the knowledge and skills that are required for musculoskeletal first contact physiotherapy. From the perspectives of existing MSK FCPs, the study sought to understand the pre-and-post-registration professional developmental journey into musculoskeletal first contact physiotherapy. Semi-structured interviews over the telephone were conducted with a self-selected and snowball sample of 15 MSK FCPs from across Britain. Framework analysis was used to analyze the interview transcripts. Four overarching themes were identified: (1) Decision to choose a career path as a MSK FCP; (2) Relevancy of pre-registration physiotherapy (PT) education for MSK FCP; (3) Relevancy of post-registration continuing professional development for MSK FCP, and; (4) Improving pre-registration PT education for the foundational knowledge and skills required to work in musculoskeletal first contact physiotherapy. Each overarching theme generated several subthemes. The research contributes to understanding the career pathway into the MSK FCP role and showed what relevant knowledge and skills were acquired for this role at pre-and-post registration levels. Findings will inform guidance for pre-registration PT curriculum development. [ABSTRACT FROM AUTHOR]

As opportunities for inclusive postsecondary education (IPSE) for students with intellectual disability have grown, the field has worked to understand the application of evidence-based practices in secondary transition and supports, such as promoting self-determination, for students with intellectual disability to have the same robust, authentic college experiences as their peers without disabilities. The authors conducted a scoping review on self-determination and IPSE, with findings indicating a small but growing body of literature. Much of the literature addresses the topic generally through practice-based descriptions, and the authors provide recommendations for future directions in research and practice.

In recent decades, the locally extinct sea otter (Enhydra lutris lutris) has been recolonizing the coast of eastern Hokkaido. Their diet includes benthic invertebrates such as bivalves, sea urchins, snails, and chitons. In the fall of 2021, a harmful algal bloom (HAB) of Karenia selliformis occurred across Hokkaido's northern and eastern coasts, leading to a massive mortality of sea urchins. This dinoflagellate produces a neurotoxin (gymnodimine) implicated in shellfish poisoning. To determine the effect of the HAB on the marine community, we conducted benthic surveys using SCUBA and visually monitored the prey items of the sea otters in the affected area from 2020 to 2023. Following the HAB, we observed an 82% decrease in benthic sea urchin density (number m2), leading to their complete absence from the diet of sea otters. Conversely, bivalve density increased six-fold, accompanied by a nearly two-fold rise in their percentage in the sea otters' diet. Minimal changes were observed in the density of chitons and snails, with no significant alteration in the sea otters' diet. Despite these changes, the impact of the HAB on otters' dietary preferences was temporary, as the percentage of dietary sea urchins began recovering one year later. Sea otters augmented their diet with bivalves to compensate for the reduced availability of sea urchins during the HAB with no apparent effects on the number of sea otters or their health. Our results highlight the adaptability of sea otters to adjust their diet according to prey availability.

Parkinson's Disease (PD) is the second most common neurodegenerative disorder behind Alzheimer's, affecting around 1% of the population over 50 years old. PD is associated with inhibited motor functions including tremors, muscle rigidity, impaired posture, bradykinesia (slowed movement) and loss of balance. Physical activity is thought to be one of the most important non-pharmacological strategies to target and improve the management of motor symptoms of PD. To identify the effect of Strength Training (ST) on Falls and Quality of Life (QOL) on people suffering with PD. A systematic search of AMED, Cinahl, Cinhal Plus, CSP Online Library Catalogue, Medline and SportDiscus was conducted; articles were searched until November 2018. Eleven studies were included in this review, with a total of 549 participants of which 539 had a confirmed diagnosis of PD, 10 did not. All eleven included studies were randomised control trials. The training volume including repetitions, sets, frequency and intensity varied between all studies. Interventions showed positive trends in reducing the proportion of fallers and improving QOL Scores. There is some evidence to show that ST is effective at improving strength in People with Parkinson's Disease (PwPD) and has some passover effects in reducing falls and improving QOL. Future research is required to determine if optimum guideline training volumes for PwPD better support the secondary effects on falls and QOL. [ABSTRACT FROM AUTHOR]

El uso de la ureteroscopia flexible, se ha convertido en un procedimiento mínimamente invasivo, eficiente y seguro para la exploración de la vía urinaria superior; asociada al uso del láser como método de fragmentación, alcanzando altas tasas libres de cálculos. Objetivo: Presentar la experiencia clínica en la Efectividad del uso del ureterorrenoscopio flexible de unsolo uso en pacientes con litiasis en el Centro Médico Docente La Trinidad año 2023. Métodos: Serealizó un estudio descriptivo retrospectivo, unicéntrico, como una investigación transversal con datos de octubre 2022 a julio del 2023, en el Centro Médico Docente la Trinidad con una población de 31 pacientes distribuidos en sexo masculino y femenino, lo cual se realizó cirugía intrarenal retrograda. Resultados: La media de edad fue de 47 años, mínimo 20, máximo 72, y un promedio de 51. El tamaño promedio de los litos fue de 8,31 mm, máximo 30mm, y el sito más frecuente el riñón 48,39%. La tasa libre de litiasis de 90%. Doble J intraoperatorio se colocó en el 100% de los pacientes. Se presentó una complicación del (3%) y 15 reintervenciones (48%). Conclusiones: El uso de ureterorenoscopio flexible y láser en el tratamiento de la litiasis renal , con diámetros mayores hasta 20 mm logró TLC (tasa libre de cálculos) equiparables con las reportadas en la literatura, con un porcentaje bajo de complicaciones, por lo tanto por ser el primer trabajo en nuestro país recomendamos su uso por los beneficios ofrecidos, menor tasa de complicaciones, infecciones y menos tiempo de hospitalización.

En la actualidad el pallet ecuatoriano no se lo comercializa como un producto de exportación; sino, como medio de transporte, por tal motivo solo se implementan normas técnicas ecuatorianas y fitosanitarias para su producción. La presente investigación descriptiva tuvo como objetivo analizar un modelo de gestión de las empresas paleteras de la provincia de El Oro, mediante la identificación de la cadena de valor; para lo cual, se emplearon la observación directa y las técnicas de búsqueda primarias y secundarias, para obtener datos sobre las variables de estudio. La investigación evidencia la existencia de secuencia lógica del proceso de elaboración del pallet; sin embargo, las distintas gestiones se las realizan de manera empírica, lo que dificulta que el producto tenga un valor agregado; lo que limita su comercialización como un producto de exportación. Es esencial establecer un modelo de gestión en base a la Norma ISO 9001:2015, dado que permite reestructurar y gestionar los procesos administrativos, productivos y de servicios para obtener un producto de calidad, acorde a las necesidades del mercado interno y/o externo.

Flexion contracture may develop after total knee arthroplasty (TKA) and is usually associated with soft tissue contracture in the posterior compartment or hamstrings. A cyclops lesion is a soft tissue mass which can form in the anterior compartment usually after anterior cruciate ligament reconstruction and has been observed after bicruciate-retaining TKA. We have treated a patient who developed progressive loss of full extension from 0° to 20° after bicruciate-retaining TKA. A large fibrous tissue mass (cyclops lesion) was identified in the anterior compartment during arthrotomy 1 year after TKA. Excision of the mass resulted in complete resolution of the flexion contracture. Keywords: Bicruciate retaining, Total knee arthroplasty, Cyclops lesion, Flexion contracture

Maintenance of high turnover in tissues such as epidermis requires balance between proliferation and differentiation. Here the authors show that HNRNPK promotes RNA Polymerase II binding to proliferation and self-renewal genes as well as degradation of differentiation promoting mRNAs together with DDX6 in epidermis.